Successful usage of a chatbot to standardize and automate history taking in Hymenoptera venom allergy
Authors: Simon Schneider, Christine Gasteiger, Hannah Wecker, Jonas Höbenreich, Tilo Biedermann, Knut Brockow, Alexander Zink
Journal: Allergy (2023)

Allergic diseases are on the rise worldwide. However, sufficient diagnostics and therapy are not always available and especially during the COVID-19 pandemic have access restrictions limited their availability to urgent cases.1, 2 Allergy history taking typically follows a logical structure and especially for Hymenoptera venom allergy, requires essential questions.2, 3 One approach to addressing the increasing number of patients and optimizing the use of resources is the application of chatbots, which can provide both patients and physicians with specific medical information including the patient's anamnesis.4, 5 Chatbot systems may be well-suited to collect medical information in an optimized and time-efficient manner. To assess the feasibility and potential of chatbots for allergy history taking, we conducted an institutional-based randomized study in Hymenoptera venom allergic patients. An HTML-based chatbot that asked questions concerning the allergological as well as general medical history was developed using Java 8+ (Sun Microsystems, Oracle; code accessible, Appendix S1). The questions were initially developed together by two allergology-experienced resident physicians and then independently reviewed and corrected by two allergology attending physicians. Fifteen patients each were randomized into a chatbot and a control group. Chatbot group patients had completed the online chatbot-based anamnesis at home. A trained allergologist received this personal information at the allergology outpatient clinic appointment and controlled the history for completeness and accuracy. Controls were conventionally questioned face-to-face at the clinic. Here, the time needed to collect the history conventionally and the time needed to verify and complete the chatbot history on-site were measured. Furthermore, satisfaction with the conventional approach as well as with the chatbot questions and the usage behaviour were assessed using a standardized questionnaire. The study was reviewed by the local ethics committee (reference number 351/21S), and all study participants provided written informed consent. Overall, there was no significant difference in demographics and clinical data between the control and chatbot group (mean age 39.5 ± 14.8 years vs. 38.3 ± 10.4 years). In each group, 12 of the 15 patients had a wasp venom allergy (80%), with anaphylaxis grade 1 being the most commonly reported (66.7% vs. 60.0%). Median duration of history taking in the chatbot group was 185 s (interquartile range (IQR): 144.00–251.00), which was significantly shorter (57.3%) than that of the control group (291 s (IQR: 265.50–359.50), p = .002, Table 1, Figure S1. Overall, the completeness of the anamnesis, evaluated by the amount of further questions that needed to be addressed in order to complete the anamnesis, was very high (73.3%) as was satisfaction with the chatbot for the majority of patients (75%). Additionally, there was a trend that patients in the chatbot group were more satisfied with the time all in all needed for the history taking than patients of the control group (Q9; 100% vs. 80%, p = .07). Two patients in the chatbot group (13.3%) were dissatisfied with the questions and found that relevant problems were documented insufficiently (Figure 1A,B). To conclude, this study demonstrated that significant time can be saved using a chatbot in the assessment of Hymenoptera venom allergies (Figure 1C). It could be shown that the completeness of the anamnesis and patient satisfaction with the chatbot anamnesis were equivalent to that of conventional in person medical history taking. However, since each patient's history can be highly individual, it was also observed that some patients experienced problems in understanding the prefabricated chatbot questions. In summary, chatbot-supported anamnesis does not replace doctor–patient contact, but it has great potential in pre-assessing and prioritizing the needs and appointments of patients with Hymenoptera venom allergies. Other disciplines, such as psychology, have already proven that chatbots are an effective way to complete patient anamneses in advance online in an easy and accessible manner.6 Additional studies with larger patient groups are needed to further explore the potential of chatbots in allergology and beyond. The authors would like to thank Michael Hindelang, Charlotte Kiani, Maximilian C. Schielein, Samuel Schöberl, and Alphina Kain for their support. The study was funded by the Department of Dermatology and Venereology, School of Medicine, Technical University of Munich, Munich, Germany. SS, CG, HW, and JH have no conflicts of interest to declare relating to this work. TB, KB, and AZ have been advisors and/or received speaker's honoraria and/or received unrestricted research grants from the following companies ALK-Abello Arzneimittel GmbH, Bencard Allergie GmbH, Phadia Thermofischer GmbH. Appendix S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.